Aging, Author Interviews, Genetic Research, JAMA, Macular Degeneration, Ophthalmology / 08.12.2016 Interview with: dr-anneke-i-den-hollanderAnneke I. den Hollander, PhD Department of Ophthalmology and Department of Human Genetics Donders Institute for Brain, Cognition, and Behaviour Radboud University Medical Center Nijmegen, the Netherland What is the background for this study? What are the main findings? Response: Age-related macular degeneration is caused by a combination of genetic and environmental factors. Rare genetic variants in the complement system have been described in AMD, but their effect remains largely unexplored. In this study we aimed to determine the effect of rare genetic variants in the complement system on complement levels and activity in serum. What are the main findings? Response: Carriers of CFI variants showed decreased FI levels, carriers of C9 Pro167Ser had increased C9 levels, while C3 and FH levels were not altered. Carriers of CFH and CFI variants had a reduced ability to degrade C3b, which for CFI was linked to reduced serum FI levels. (more…)
Author Interviews, Dermatology, Electronic Records, JAMA, Outcomes & Safety, Surgical Research / 08.12.2016 Interview with: Sophia Akhiyat M.D. Candidate, Class of 2017 The George Washington University School of Medicine and Health Sciences METEOR Fellowship What is the background for this study? What are the main findings? Response: Our study was inspired by one of Choudhry et al,1 in which patients' preferences for skin biopsy result disclosure was surveyed at melanoma clinics affiliated with several academic institutions. We sought to broaden participant inclusion criteria by evaluating patients' preferences at a general dermatology clinic at an academic center. Our findings support that the highest ranked patient-preferred method for receiving skin biopsy results was through an online portal. Patients also reported that the most important factors when selecting a modality for communication were the amount of information given and time available to discuss results. We also observed a relationship between a younger patient age range and online portal experience as well as a preference for biopsy notification via online portal. 1Choudhry A, Hong J, Chong K, et al. Patients' Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods. JAMA Dermatol. 2015;151(5):513-521. (more…)
ADHD, Author Interviews, Education, JAMA, UCSF / 08.12.2016 Interview with:  

Lisa Meeks , PhD Director, Medical Student Disability UCSF Medical Center What is the background for this study? What are the main findings? Response: This was the first study to include students with AD/HD, learning, psychological, and chronic health conditions. This study found that the prevalence of students with disabilities is up to four times higher than previous studies indicated.

AD/HD, learning, and psychological disabilities were the most prevalent, suggesting that most students with disabilities in medicine have non-apparent disabilities. Within MD granting programs, the number of students self-reporting disability varied between 0% and 12%. Explanations for the high variability between programs are unknown, however, anecdotal reports suggest the degree to which programs have dedicated resources and inclusive practices for students with disabilities influence student disclosure. (more…)
Author Interviews, Dermatology, JAMA, Pediatrics / 07.12.2016 Interview with: Steve Xu MD, MSc Resident Physician Department of Dermatology Northwestern Feinberg School of Medicine What is the background for this study? What are the main findings? Response: Given the limited data on the effectiveness or safety of the different moisturizers examined in the study, how much do you think parents should decide what to use on their babies based on the "cost-effectiveness" determined in this study? Would you just say cheapest is best since we don't know how well these things work? Or what's the message? Price. Petrolatum is an extremely effective moisturizer. It also happens to be one of the most affordable. Unlike adults, I don't suspect newborns will complain too much about the greasiness of petrolatum. They're less concerned that their work clothes will get ruined. They are less likely to care about cosmetic elegance. I also will say that petrolatum is less likely to include any artificial fragrances, preservatives that could serve as irritants or allergens in the future. That's an added bonus. (more…)
Author Interviews, Education, JAMA / 06.12.2016 Interview with: Karen E. Hauer, MD, PhD Associate Dean, Competency Assessment and Professional Standards Professor of Medicine, UCSF San Francisco, CA  94143 What is the background for this study? Response: As part of the Accreditation Council for Graduate Medical Education (ACGME)’s Next Accreditation System, residency programs are now required to rate residents using the Milestones. Evidence of validity of Milestone ratings is needed to show whether this rating system measures meaningful aspects of residents’ practice. In the field of internal medicine, we compared ratings of residents using the old evaluation form, the pre-2015 Resident Annual Evaluation Summary (RAES), which has a non-developmental rating scale that rates residents from unsatisfactory to superior on a 9-point scale, with developmental Milestone ratings. This was a cross-sectional study of all United States internal medicine residency programs in 2013-14, including 21,284 internal medicine residents. Milestone ratings are submitted by residency program directors working with Clinical Competency Committees. We correlated RAES and Milestone ratings by training year; correlated ratings of Medical Knowledge milestones using the two systems with American Board of Internal Medicine (ABIM) certification examination scores; and examined ratings of unprofessional behavior using the two systems. (more…)
Aging, Author Interviews, Cancer Research, Global Health, JAMA / 06.12.2016 Interview with: Christina Fitzmaurice, MD, MPH Assistant Professor Department of Medicine, Division of Hematology Institute for Health Metrics and Evaluation University of Washington Seattle, WA What is the background for this study? What are the main findings? Response: Cancer is the second leading cause of death worldwide behind cardiovascular diseases. We found that cancer cases increased by 33% from 13.1 million cases in 2005 to 17.5 million in 2015. The largest driver behind this increase was an aging population, followed by a growing population worldwide. The smallest factor contributing to this increase was a rise in cancer incidence rates. Because of increasing life expectancy and better control of communicable diseases cancer will remain a major burden in the foreseeable future. Adjusting and building health systems that can appropriately deal with this challenge is only possible with good data on the burden of cancer. In our study we estimate the number of cancer cases, and cancer deaths over time for 32 cancers in 195 countries and territories from 1990 to 2015. We also estimate how many years of life were lost due to cancer as well as disability adjusted life years and a summary measure that combines these two into disability adjusted life years. (more…)
Author Interviews, Exercise - Fitness, Frailty, JAMA / 06.12.2016 Interview with: Maayan Agmon, PhD The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Studies University of Haifa Haifa, Israel What is the background for this study? What are the main findings? Response: To address the issue of functional decline during and post hospitalization . Up to 40% of older adults decline in their function at the time of hospitalization and acute illness. Most part of this functional decline is not explained by illness itself. So far, we know that in-hospital mobility is a protective factor but how much walking is required to prevent this decline has yet to be determined. (more…)
Author Interviews, Colon Cancer, JAMA / 03.12.2016 Interview with: David Lieberman MD Professor of Medicine Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University Portland, OR 97239 What is the background for this study? What are the main findings? Response: New guidelines for colorectal cancer (CRC) screening from the USPSTF were published in June 2016. They recommended any of 8 different screening programs. The purpose of this review was to highlight elements not included in the USPSTF report: 1. Elements of informed decision making associated with each program 2. Quality metrics for each program 3. Recommendations for higher than average risk individuals (more…)
Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Depression, JAMA / 03.12.2016 Interview with: Zahinoor Ismail MD FRCPC Clinical Associate Professor, Hotchkiss Brain Institute University of Calgary What is the background for this study? What are the main findings? Response: Depression and depressive symptoms are common in mild cognitive impairment (MCI). Evidence suggests that depression in MCI increases the likelihood of progression from MCI to dementia, compared to non-depressed people with MCI. In the newer construct of mild behavioural impairment (MBI), which describes the relationship between later life onset of sustained and impactful neuropsychiatric symptoms and the risk of cognitive decline and dementia, depression is an important subdomain (in addition to apathy, impulse control, social cognition and psychotic symptoms). Thus, depression and depressive symptoms are a significant risk factor for cognitive, behavioural and functional outcomes in older adults who have at most mild cognitive impairment. As the importance of neuropsychiatric symptoms in older adults emerges, good prevalence estimates are required to inform clinicians and researchers as well as public health policy and decision makers. We performed a systematic review and meta-analysis to determine the best estimate of prevalence of depression in  mild cognitive impairment. We included 57 studies, representing 20,892 participants in the analysis. While we determined that the omnibus prevalence estimate was 32%, there was significant heterogeneity in this sample based on setting. In community samples, the rate was 25%, but in clinical samples this was higher at 40%. Additionally, different case ascertainment methods for depression (self report, clinician administered or caregiver report) and different MCI criteria didn't change the prevalence estimates. (more…)
Author Interviews, FDA, JAMA, Ophthalmology / 02.12.2016 Interview with: Malvina Eydelman, M.D. Division Director; Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health FDA. What is the background for this study? Response: In October 2009, the FDA, the National Eye Institute (NEI), and the Department of Defense (DoD) launched the LASIK Quality of Life Collaboration Project (LQOLCP) to help better understand the potential risk of severe problems that can result from LASIK. The project aimed to develop a tool to determine the percent of patients who develop difficulties performing their usual activities following LASIK, and to identify predictors for those patients. At the time we developed our project, there was a limited amount of valid scientific data on certain patient-reported outcomes (PROs) related to LASIK. A PRO is a report of a condition experienced and reported by the patient, not the health care provider. Most LASIK studies used tools, such as questionnaires, to assess visual symptoms, but only after the surgery. The Patient-Reported Outcomes with LASIK (PROWL) studies in the LQOLCP assessed visual symptoms both before and after their LASIK surgery to identify changes over time. The studies also measured the impact symptoms directly had on performing usual activities, which had not previously been done. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, Johns Hopkins / 02.12.2016 Interview with: Dr. Amol K. Narang, MD Instructor of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins Sidney Kimmel Comprehensive Cancer Center What is the background for this study? Response: We know that cancer care is becoming increasingly expensive in the U.S., but the financial impact on patients in the form of out-of-pocket expenses is not well understood, in part because of the lack of data sources that track this information. As such, we used the Health and Retirement study, a national panel study that closely tracks the out-of-pocket medical expenditures of older Americans, to understand the level of financial strain that Medicare patients experience after a new diagnosis of cancer. We further investigated what factors were associated with high financial strain and what type of health services were driving high costs in this population. (more…)
Author Interviews, CDC, JAMA, Lipids, Nutrition / 02.12.2016 Interview with: Asher Rosinger, PHD, MPH Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention Division of Health and Examination Nutrition Examination Surveys, Analysis Branch National Center for Health Statistic What is the background for this study? Response: Total cholesterol, triglycerides, and low-density lipoprotein (LDL) levels are linked to coronary heart disease and cardiovascular events. Between 1999 and 2010, total cholesterol, triglycerides, and LDL levels declined among U.S. adults. We used new data from the 2011-2014 nationally representative National Health and Nutrition Examination Survey (NHANES) to determine if earlier trends continued. (more…)
Author Interviews, Insomnia, JAMA / 02.12.2016 Interview with: Lee M. Ritterband, Ph.D. Professor, Department of Psychiatry and Neurobehavioral Sciences Director, Center for Behavioral Health and Technology University of Virginia School of Medicine Ivy Foundational Translational Research Building Charlottesville, VA 22903 What is the background for this study? Response: Cognitive behavioral therapy for insomnia, a non-pharmacological intervention, is the first line recommendation for adults with chronic insomnia (see recommendations made earlier this year from the American College of Physicians). Access to CBT-I, however, is limited by numerous barriers, including a limited supply of behavioral medicine providers. One way to help improve access to this effective treatment is to develop and evaluate additional delivery methods of CBT-I, including Internet-delivered CBT-I. This study was designed to evaluate the efficacy of an Internet-delivered CBT-I program (SHUTi: Sleep Healthy Using The Internet) over the short-term (9-weeks) and long-term (1-year). (more…)
Author Interviews, Frailty, JAMA, Surgical Research, University of Pittsburgh / 01.12.2016 Interview with: Daniel E. Hall, MD, MDiv, MHSc, FACS Associate Professor of Surgery University of Pittsburgh Staff Surgeon VA Pittsburgh Healthcare System Core Investigator VA Center for Health Equity Research and Promotion. PIttsburgh, PA What is the background for this study? What are the main findings? Response: A growing body of research demonstrates that frailty is a more powerful predictor of postoperative outcomes than risk-prediction models based on age or comorbidity alone. However, it has not been clear if surgeons could intervene on frailty to improve outcomes. This study reports what we believe to be the first ever demonstration that it is not only feasible to screen an entire health system for frailty, but that it is possible to act on that information to improve outcomes. Every patient evaluated for elective surgery was screened for frailty with a brief tool that takes 1-2 minutes to complete. Those identified as potentially frail and thus at greater risk for poor surgical outcomes received an ad-hoc administrative review aimed at optimizing perioperative care. After implementing the frailty screening initiative, we observed a 3-fold increase in long-term survival at 6 and 12 months—even after controlling for age, frailty, and predicted mortality. (more…)
Author Interviews, JAMA, Outcomes & Safety / 30.11.2016 Interview with: Jianhui Hu, PhD Center for Health Policy & Health Services Research Henry Ford Health System Detroit, Michigan What is the background for this study? What are the main findings? Response: In July of 2016, the Center for Medicare and Medicaid services (CMS) released its first-ever hospital Star Rating for consumers to use to compare hospital quality. Since earlier studies have shown that hospitals serving lower-socioeconomic-status (SES) communities have lower scores on measures like readmission rate that are a part of the Star Rating system, we wanted to find out whether a similar relationship might be found between community-level SES and the Star Ratings. Our study used a recently released “stress” ranking of 150 most populated U.S cities and explored possible associations with the hospital Star Ratings. This “stress” ranking was a composite score of 27 individual metrics measuring a number of characteristics of the cities, such as job security, unemployment rate, housing affordability, poverty, mental health, physical activity, health condition, crime rate, etc. Our study found that less-stressed cities had average higher hospital Star Ratings (and more-stressed cities had lower average hospital Star Ratings). Cities such as Detroit and Newark are good examples of those with high “stress” and relatively low hospital Star Ratings, and cities like Madison and Sioux Falls of those with relatively low stress and relatively high hospital Star Ratings. Our correlational analysis indicated that around 20% of the difference in the Star Ratings can be explained by characteristics of the cities in which hospitals were located. (more…)
Author Interviews, End of Life Care, JAMA, University of Pittsburgh / 30.11.2016 Interview with: Dr. Dio Kavalieratos, PhD Assistant Professor of Medicine Section of Palliative Care and Medical Ethics Division of General Medicine Institute of Clinical Research University of Pittsburgh What is the background for this study? What are the main findings? Response: The field of palliative care has seen a dramatic surge in research and clinical implementation over the past decade. The last systematic review of palliative care trials was published in 2008. In that review, the authors reported very weak evidence for palliative care, as well as major methodological limitations in the trials that had been done to date. Since then, several landmark trials have been published, some with very compelling findings such increased survival. Therefore, an up-to-date review was in order. There also had not previously been enough trials to perform a meta-analysis. A meta-analysis is the statistical process of combining the results of multiple trials, which gives you an overall effect for an intervention, in this case, palliative care. We were able to conduct the first meta-analysis of the effect of palliative care with three important outcomes: patient quality of life, patient symptom burden, and patient survival. (more…)
Author Interviews, JAMA, Neurological Disorders, Radiology, UCLA / 28.11.2016 Interview with: Joseph O’Neill, PhD Division of Child and Adolescent Psychiatry University of California–Los Angeles Semel Institute for Neuroscience Los Angeles What is the background for this study? What are the main findings? Response: Stuttering seriously diminishes quality of life. While many children who stutter eventually grow out of it, stuttering does persist into adulthood in many others, despite treatment. Like earlier investigators, we are using neuroimaging to explore possible brain bases of stuttering, aiming, eventually, to improve prognosis. What's novel is that our study deploy neuroimaging modalities-- arterial spin labelling and, in this paper, magnetic resonance spectroscopy (MRS)-- not previously employed in stuttering. MRS offers prospects of detecting possible neurochemical disturbances in stuttering. The MRS results showed differences in neurometabolite-- brain chemicals-- levels between people who stutter (adults and children) and those who don't in many brain regions where other neuroimaging has also observed effects of stuttering. In particular, MRS effects were apparent in brain circuits where our recent fMRI work detected signs of stuttering, circuits subserving self-regulation of speech production, attention and emotion. This reinforces the idea that stuttering has to do with how the brain manages its own activity along multiple dimensions: motivation, allocation of resources, and behavioral output. (more…)
Author Interviews, Cancer Research, JAMA, Lung Cancer / 27.11.2016 Interview with: Paul W. Sperduto, MD, MPP, FASTRO Minneapolis Radiation Oncology University of Minnesota Gamma Knife Center, Minneapolis, Minnesota What is the background for this study? What are the main findings? Response: Analysis of past randomized clinical trials involving patients with brain metastases, an extremely heterogeneous population, suggested that the stratification tools of the past were inadequate to ensure those trials were comparing similar patients which made the results of those trials difficult to interpret or misleading. So, in 2008, a new prognostic index, the Graded Prognostic Assessment (GPA) was designed and published to more accurately predict survival. In 2010, the GPA was refined when we learned survival and the factors that predict survival varied by diagnosis (i.e. lung, breast, melanoma, kidney cancer patients with brain metastases had different survival). Now we have learned survival also varies by gene mutations and the diagnosis-specific GPA for lung cancer is further refined in this article with this new information, specifically EGFR and ALK gene alterations. 27 co-authors from 12 academic medical centers contributed patients to this database which represents the largest study of lung cancer patients with brain metastases ever reported. (more…)
Author Interviews, Heart Disease, JAMA / 22.11.2016 Interview with: Vinay Kini, MD, MS Division of Cardiovascular Medicine Hospital of the University of Pennsylvania The Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia What is the background for this study? What are the main findings? Response: Recent studies have shown that use of cardiac stress tests has declined by about 25% among Medicare beneficiaries and by about 50% in Kaiser Permanente over the last several years. However, the reasons for these declines is not well understood. Decreases in the use of stress testing could be due to dissemination of appropriate use criteria and other clinical practice guidelines, advances in preventive care, reductions in reimbursement for testing, or other health system organizational characteristics. Therefore, our goal was to determine whether similar declines in testing are observed among a nationally representative cohort of commercially insured patients. We identified over 2 million stress tests performed among 33 million members of the commercial insurance company, and found that there was a 3% increase in the overall use of stress testing in this cohort between 2005 and 2012. Declines in the use of nuclear SPECT tests were offset by increases in the use of stress echocardiography, exercise electrocardiography, and newer stress test modalities such as coronary computed tomography angiography. The largest increase in use of testing was seen among younger individuals - there was a 60% increase in use of testing among patients aged 25-34, and a 30% increase among individuals aged 35-44. (more…)
Author Interviews, Cancer Research, Dermatology, JAMA, UCLA / 22.11.2016 Interview with: Albert Yoon-Kyu Han, PhD Class of 2017 Medical Scientist Training Program David Geffen School of Medicine at UCLA What is the background for this study? What are the main findings? Response: Squamous cell carcinoma (SCC) of the lip makes up a large portion of oral cancers (25%). Most of the demographic and prognostic indicators for lip SCC are only available through retrospective case series. Thus, we used the national cancer database (Surveillance, Epidemiology, and End Results, or SEER) to examine the incidence, treatment, and survival of patients with lip SCC. The main findings of this study were that lip Squamous cell carcinoma predominantly affects white men in their mid-60s. We also found that the determinants of survival for lip SCC include age at diagnosis, primary site, T stage, and N stage. More specifically, on the primary site, SCC of the upper and lower lip had similar survival, whereas SCC of the oral commissure was associated with decreased survival. (more…)
ADHD, Author Interviews, JAMA, Neurological Disorders, NIH / 22.11.2016 Interview with: Gustavo Sudre, PhD Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch National Human Genome Research Institute Bethesda, Maryland What is the background for this study? What are the main findings? Response: ADHD is the most common childhood neuropsychiatric disorder, affecting 7-9% of school age children. It is highly heritable (h2=0.7), but few risk genes have been identified. In this study, we aimed to provide quantitative brain-based phenotypes to accelerate gene discovery and understanding. ADHD is increasingly viewed as resulting from anomalies of the brain’s connectome. The connectome is comprised of the structural connectome (white matter tracts joining different brain regions) and the functional connectome (networks of synchronized functional activity supporting cognition). Here, we identified features of the connectome that are both heritable and associated with ADHD symptoms. (more…)
Author Interviews, Blood Pressure - Hypertension, Bone Density, JAMA, Kaiser Permanente, Osteoporosis, Pharmacology / 22.11.2016 Interview with: Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096 What is the background for this study? Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis. Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified. After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion. (more…)
Author Interviews, JAMA, Neurological Disorders, Parkinson's / 21.11.2016 Interview with: Adolfo Ramirez Zamora, MD Associate Professor of Neurology and Phyllis E. Dake Endowed Chair in Movement Disorders Department of Neurology Albany Medical College What is the background for this study? What are the main findings? Response: Patients with SPG 11 mutations can present with motor symptoms characterized by juvenile onset dystonia, Parkinsonism and lower extremity spasticity. Parkinsonism appears to be responsive to levodopa therapy early in the disease but treatment is complicated by the occurrence of motor fluctuations resembling parkinson disease. Patients have short duration of medication effects, unpredictable response to medications along with generalized, excessive involuntary movements known as dyskinesias. Deep Brain stimulation is a well-established treatment for movement disorders but it has never been used in this disease. We first report the clinical outcome obtained with globus pallidus internal deep brain stimulation in a patient with parkinsonism, dystonia, dyskinesias related to SPG 11. Additionally, we report for the first time the basal ganglia changes observed in the disease using intraoperative neuronal recordings. Patient had a sustained and remarkable response to stimulation over the next two years without side effects. Neurophysiologic changes revealed a unique pattern of neuronal firing despite of the resemblance to advance Parkinsons disease. (more…)
Author Interviews, Heart Disease, JAMA / 21.11.2016 Interview with: Dr. Doug Owens MD former USPSTF Task Force member Professor at Stanford University Henry J. Kaiser, Jr. Professor Director of the Center for Health Policy Freeman Spogli Institute for International Studies Center for Primary Care and Outcomes Research Department of Medicine and School of Medicine Stanford What is the background for review and statement? Response: Cardiovascular disease is serious—it can lead to heart attacks and strokes, and is responsible for one in every three adult deaths in the U.S. People with no signs or symptoms and no past history of cardiovascular disease can still be at risk. Fortunately, some people can benefit from taking a medication called statins to reduce that risk. (more…)
Author Interviews, Autism, JAMA, Pediatrics / 20.11.2016 Interview with: Dr. Melanie Penner, MD FRCP (C) Clinician investigator and developmental pediatrician Holland Bloorview Kids Rehabilitation Hospital What is the background for this study? What are the main findings? Response: Studies have shown that accessing intensive behavioral intervention (IBI) services at younger ages is associated with improved outcomes for children with autism spectrum disorder (ASD). In Ontario, Canada, children wait years to access publicly-funded IBI. This analysis estimated costs and projected adult independence for three IBI wait time scenarios: the current wait time, a wait time reduced by half, and an eliminated wait time. The model inputs came from published literature. The main findings showed that eliminating the wait time generated the most independence and cost the least amount of money to both the government and society. With no wait time for intensive behavioral intervention, the government would save $53,000 (2015 Canadian dollars per person) with autism spectrum disorder over their lifetime, and society would save $267,000 (2015 Canadian dollars). (more…)
Author Interviews, JAMA, Mental Health Research / 19.11.2016 Interview with: Guillermo Horga, MD, PhD Assistant Professor of Clinical Psychiatry Columbia University Medical Center What is the background for this study? Response: Some people who eventually develop schizophrenia or other psychotic disorders have early “prodromal” symptoms such as subtle perceptual abnormalities and unusual thoughts that precede the onset of these disorders by months or even years. These subtle symptoms are typically not fully formed or met with full conviction, which distinguishes them from full-blown symptoms of psychosis. The “prodromal” phase has been the subject of intense study as researchers believe it can provide an invaluable window into the neurobiological processes that cause psychotic disorders as well as an opportunity to develop early preventive interventions. Persons who experience “prodromal” symptoms (known as “clinical high-risk” individuals) tend to report a variety of relatively subtle perceptual abnormalities (e.g., heightened sensitivity to sounds, distortions in how objects are perceived, momentarily hearing voices of speakers who are not present), unusual thoughts, and disorganized speech, some of which have been shown to be particularly informative in distinguishing who among these persons will eventually develop a full-blown psychotic disorder, a prediction that is clinically important as it may indicate the need for close monitoring of individuals who are at the greatest risk. Even though subtle perceptual abnormalities are common in this population, the available research indicates that they are as a whole uninformative for clinical prediction purposes. However, previous research in this area had never examined in detail whether assessing perceptual abnormalities in different sensory domains (such as visual versus auditory abnormalities) separately could be more informative than assessing them as a whole. (more…)
Author Interviews, Gender Differences, JAMA, Stroke / 19.11.2016 Interview with: Catharina J. M. Klijn, MD Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery University Medical Center Utrecht, Utrecht Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience Department of Neurology Radboud University Nijmegen Medical Centre Nijmegen, the Netherlands What is the background for this study? Response: The incidence of stroke is higher in men than in women. This difference attenuates with increasing age. Established risk factors for stroke, such as hypertension, cigarette smoking and ischemic heart disease are more prevalent in men but only partly explain the difference in stroke incidence. The contribution of oral contraceptive use and hormone therapy to stroke risk has been previously reviewed. We aimed to evaluate what is known on other female- and male specific risk factors for ischemic and hemorrhagic stroke incidence and stroke mortality through a systematic review and meta-analysis of 78 studies including over 10 million participants. (more…)
Author Interviews, CT Scanning, Heart Disease, JAMA, Women's Heart Health / 16.11.2016 Interview with: Maryam Kavousi MD, PhD, FESC Assistant Professor Department of Epidemiology Erasmus University Medical Center Rotterdam The Netherlands What is the background for this study? What are the main findings? Response: The most recent American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular disease (CVD) prevention guidelines recommend statins for a larger proportion of populations. Notably, a large group of women are categorized as low CVD risk by the guidelines and would therefore not typically qualify for intensive management of their standard risk factors. Coronary artery calcium (CAC) scanning allows for the detection of subclinical coronary atherosclerosis and is viewed as the vessel’s memory of lifetime exposure to risk factors. We therefore aimed to address the utility of CAC as a potential tool for refining CVD risk assessment in asymptomatic women at low CVD risk based on the new guidelines. This study involved data on 6,739 low-risk women from 5 population-based cohort studies across the United States and Europe. We found that CAC was present in 36% of low-risk women and was associated with increased risk of CVD. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Pharmacology / 16.11.2016 Interview with: Paul J. Hauptman, MD Professor Internal Medicine, Division of Cardiology Health Management & Policy, School of Public Health What is the background for this study? What are the main findings? Response: We decided to evaluate the cost of generic heart failure medications after an uninsured patient of ours reported that he could not fill a prescription for digoxin because of the cost for a one month's supply: $100. We called the pharmacy in question and confirmed the pricing. At that point we decided to explore this issue more closely. We called 200 retail pharmacies in the bi-state, St. Louis metropolitan area, 175 of which provided us with drug prices for three generic heart failure medications: digoxin, carvedilol and lisinopril. We found significant variability in the cash price for these medications. Combined prices for the three drugs ranged from $12-$400 for 30 day supply and $30-$1,100 for 90 day supply. The variability was completely random, not a function of pharmacy type, zip code, median annual income, region or state. In fact, pricing even varied among different retail stores of the same pharmacy chain. (more…)